{"hospital_name":"Munising Memorial Hospital","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Munising Memorial Hospital"],"hospital_address":["1500 Sand Point Rd, Munising, MI 49862"],"license_information":{"license_number":"1060000115","state":"MI"},"type_2_npi":["1063414233"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Jorri Tremain"},"modifier_information":[{"description":"Medicaid level of care 6, as defined by each state","code":"U6","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes","code":"TB","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Via interactive audio and video telecommunication systems","code":"GT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Surgical Care Only","code":"54","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Postoperative Management Only","code":"55","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System","code":"95","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Clia waived test","code":"QW","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Modifier description not available","code":"93","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital","code":"PN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Separate structure, a service that is distinct because it was performed on a separate organ/structure","code":"XS","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day","code":"GG","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Care Network Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meritain Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Priority Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"TNKase","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242012047","type":"NDC"}],"standard_charges":[{"gross_charge":35470.8,"discounted_cash":35470.8,"setting":"both","billing_class":"facility","additional_generic_notes":"NDC EA = 50 MG"}]},{"description":"Platinol","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010351","type":"NDC"}],"standard_charges":[{"gross_charge":100.26,"discounted_cash":100.26,"setting":"both","billing_class":"facility","additional_generic_notes":"NDC EA = 50 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XRAY HAND 3 VIEW RT-FAC/TEC-P","code_information":[{"code":"2922572","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XRAY HIP UNI 1 VIEW-FAC/TECH","code_information":[{"code":"2922578","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility"}]},{"description":"XRAY HIP 2-3 VIEW RT-FAC/TEC","code_information":[{"code":"2922581","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","modifiers":"TC,RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XRAY HIP BI 2 VIEW-FAC","code_information":[{"code":"2922587","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"CPT"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility"}]},{"description":"XRAY HIP BI 2 VIEW-FAC-P","code_information":[{"code":"2922587","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"CPT"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"professional"}]},{"description":"XRAY HIP BI 3 OR 4V-FAC/TECH-P","code_information":[{"code":"2922590","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"CPT"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XRAY FEMUR 2/> VW-FAC/TECH","code_information":[{"code":"2922599","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility"}]},{"description":"XRAY FEMUR 2/> VW-FAC/TECH-P","code_information":[{"code":"2922599","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"CPT"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"XRAY KNEES BIL STAND-FAC/TECH-P","code_information":[{"code":"2922611","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XRAY KNEES BIL STAND-FAC/TECH","code_information":[{"code":"2922611","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility"}]},{"description":"XRAY LOWER LEG-FAC/TECH-P","code_information":[{"code":"2922614","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":99.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"XRAY ANKLE-FAC/TECH","code_information":[{"code":"2922623","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility"}]},{"description":"XRAY ANKLE-FAC/TECH-P","code_information":[{"code":"2922623","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"CPT"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY KNEE 3 VIEW BIL-FAC/TECH","code_information":[{"code":"2922625","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","modifiers":"TC,50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY KNEE 3 VIEW BIL-FAC/TECH-P","code_information":[{"code":"2922625","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","modifiers":"TC,50","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier 50: Bilateral Procedure"}]},{"description":"XRAY FOOT 2 VIEW-FAC/TECH","code_information":[{"code":"2922626","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility"}]},{"description":"XRAY FOOT 2 VIEW-FAC/TECH-P","code_information":[{"code":"2922626","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":96.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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ILIOINGUIN/ILOHYPOGAST-PCF","code_information":[{"code":"2950065","type":"CDM"},{"code":"361","type":"RC"},{"code":"64425","type":"CPT"}],"standard_charges":[{"gross_charge":2005.0,"discounted_cash":2005.0,"setting":"both","billing_class":"facility"}]},{"description":"NB PUDENDAL INJ-PCF","code_information":[{"code":"2950066","type":"CDM"},{"code":"361","type":"RC"},{"code":"64430","type":"CPT"}],"standard_charges":[{"gross_charge":2526.0,"discounted_cash":2526.0,"setting":"both","billing_class":"facility"}]},{"description":"NB SCIATIC BIL-PCF","code_information":[{"code":"2950067","type":"CDM"},{"code":"361","type":"RC"},{"code":"64445","type":"CPT"}],"standard_charges":[{"gross_charge":3008.0,"discounted_cash":3008.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"NB SCIATIC 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standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FACET CER/THORA LEV 1 LT-PCF","code_information":[{"code":"2950087","type":"CDM"},{"code":"361","type":"RC"},{"code":"64490","type":"CPT"}],"standard_charges":[{"gross_charge":2893.0,"discounted_cash":2893.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FACET CER/THOR L2 ADD BIL-PCF","code_information":[{"code":"2950088","type":"CDM"},{"code":"361","type":"RC"},{"code":"64491","type":"CPT"}],"standard_charges":[{"gross_charge":1933.0,"discounted_cash":1933.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier 50: Bilateral 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOREARM RT","code_information":[{"code":"3201092","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":705.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOREARM RT-P","code_information":[{"code":"3201092","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"CPT"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT 2 VIEW LT","code_information":[{"code":"3201111","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":557.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOOT 2 VIEW LT-P","code_information":[{"code":"3201111","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOOT 2 VIEW RT","code_information":[{"code":"3201112","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":557.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT 2 VIEW RT-P","code_information":[{"code":"3201112","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"CPT"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOOT RT-P","code_information":[{"code":"3201132","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":68.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT RT","code_information":[{"code":"3201132","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"CPT"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":643.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT W OS CALCIS (HEEL) LT-P","code_information":[{"code":"3201147","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOOT W OS CALCIS (HEEL) LT","code_information":[{"code":"3201147","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":861.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"FOOT W OS CALCIS (HEEL) RT","code_information":[{"code":"3201148","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":861.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT W OS CALCIS (HEEL) RT-P","code_information":[{"code":"3201148","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"CPT"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":57.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT DIGITS RT","code_information":[{"code":"3201151","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":557.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"FOOT DIGITS RT-P","code_information":[{"code":"3201151","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"CPT"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HAND 2 VIEW LT-P","code_information":[{"code":"3201196","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"CPT"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":62.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HAND RT","code_information":[{"code":"3201261","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":727.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HAND RT-P","code_information":[{"code":"3201261","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"CPT"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HAND-DIGITS RT","code_information":[{"code":"3201281","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":630.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HAND-DIGITS RT-P","code_information":[{"code":"3201281","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HAND-DIGITS LT-P","code_information":[{"code":"3201282","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":73.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HAND-DIGITS LT","code_information":[{"code":"3201282","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"CPT"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":630.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP BILATERAL 2 VIEW-P","code_information":[{"code":"3201290","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"CPT"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HIP BILATERAL 2 VIEW","code_information":[{"code":"3201290","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"CPT"}],"standard_charges":[{"gross_charge":866.0,"discounted_cash":866.0,"setting":"both","billing_class":"facility"}]},{"description":"HIP UNI 4/> VIEW LT","code_information":[{"code":"3201302","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":612.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP UNI 4/> VIEW LT-P","code_information":[{"code":"3201302","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP UNI 4/> VIEW RT","code_information":[{"code":"3201303","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":612.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HIP UNI 4/> VIEW RT-P","code_information":[{"code":"3201303","type":"CDM"},{"code":"320","type":"RC"},{"code":"73503","type":"CPT"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":115.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HIP UNI 2-3 VIEW LT","code_information":[{"code":"3201304","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":612.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP UNI 2-3 VIEW LT-P","code_information":[{"code":"3201304","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":92.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP UNI 2-3 VIEW RT-P","code_information":[{"code":"3201305","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":92.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HIP UNI 2-3 VIEW RT","code_information":[{"code":"3201305","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"CPT"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":612.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HIP UNI 1 VIEW LT","code_information":[{"code":"3201306","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":612.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP UNI 1 VIEW LT-P","code_information":[{"code":"3201306","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":64.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HIP UNI 1 VIEW RT","code_information":[{"code":"3201307","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":612.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HIP UNI 1 VIEW RT-P","code_information":[{"code":"3201307","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"CPT"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":64.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HIP BIL 3-4 VIEWS","code_information":[{"code":"3201308","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"CPT"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility"}]},{"description":"HIP BIL 3-4 VIEWS-P","code_information":[{"code":"3201308","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"CPT"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"HUMERUS LT","code_information":[{"code":"3201371","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":705.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HUMERUS LT-P","code_information":[{"code":"3201371","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HUMERUS RT","code_information":[{"code":"3201372","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":705.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HUMERUS RT-P","code_information":[{"code":"3201372","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"CPT"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HYSTEROSALPINGOGRAM","code_information":[{"code":"3201390","type":"CDM"},{"code":"329","type":"RC"},{"code":"74740","type":"CPT"}],"standard_charges":[{"gross_charge":2120.0,"discounted_cash":2120.0,"setting":"both","billing_class":"facility"}]},{"description":"HYSTEROSALPINGOGRAM-P","code_information":[{"code":"3201390","type":"CDM"},{"code":"329","type":"RC"}],"standard_charges":[{"gross_charge":1464.0,"discounted_cash":1464.0,"setting":"both","billing_class":"professional"}]},{"description":"IV PYELOGRAM W OR WO TOMO","code_information":[{"code":"3201440","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"CPT"}],"standard_charges":[{"gross_charge":1968.0,"discounted_cash":1968.0,"setting":"both","billing_class":"facility"}]},{"description":"IV PYELOGRAM W OR WO TOMO-P","code_information":[{"code":"3201440","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1359.0,"discounted_cash":1359.0,"setting":"both","billing_class":"professional"}]},{"description":"KIDDEGRAM FOR FOREIGN BODY-P","code_information":[{"code":"3201465","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"CPT"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":59.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"KIDDEGRAM FOR FOREIGN BODY","code_information":[{"code":"3201465","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"CPT"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":473.0,"setting":"both","billing_class":"facility"}]},{"description":"KNEES BILAT STANDING AP ONLY","code_information":[{"code":"3201469","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":465.0,"setting":"both","billing_class":"facility"}]},{"description":"KNEES BILAT STANDING AP ONLY-P","code_information":[{"code":"3201469","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"CPT"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":68.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"KNEE 3 VIEW-LT","code_information":[{"code":"3201470","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":588.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"KNEE 3 VIEW-LT-P","code_information":[{"code":"3201470","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"KNEE 3 VIEW-RT-P","code_information":[{"code":"3201471","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"KNEE 3 VIEW-RT","code_information":[{"code":"3201471","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"CPT"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":588.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"KNEE FULL SERIES RT-P","code_information":[{"code":"3201481","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"KNEE FULL SERIES RT","code_information":[{"code":"3201481","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT"}],"standard_charges":[{"gross_charge":969.0,"discounted_cash":969.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"KNEE FULL SERIES LT","code_information":[{"code":"3201482","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT"}],"standard_charges":[{"gross_charge":969.0,"discounted_cash":969.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"KNEE FULL SERIES LT-P","code_information":[{"code":"3201482","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"CPT"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"KNEE-LIMITED VIEWS LT","code_information":[{"code":"3201491","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":588.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"KNEE-LIMITED VIEWS LT-P","code_information":[{"code":"3201491","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":67.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"KNEE-LIMITED VIEWS RT","code_information":[{"code":"3201492","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":588.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"KNEE-LIMITED VIEWS RT-P","code_information":[{"code":"3201492","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"CPT"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":67.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"LOWER LEG 2 VIEW LT","code_information":[{"code":"3201611","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":721.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"LOWER LEG 2 VIEW LT-P","code_information":[{"code":"3201611","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":62.0,"setting":"both","modifiers":"TC,LT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"LOWER LEG 2 VIEW RT-P","code_information":[{"code":"3201612","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":62.0,"setting":"both","modifiers":"TC,RT","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"LOWER LEG 2 VIEW RT","code_information":[{"code":"3201612","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"CPT"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":721.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"LOWER SPINE 2 OR 3 VIEW-P","code_information":[{"code":"3201630","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":79.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"LOWER SPINE 2 OR 3 VIEW","code_information":[{"code":"3201630","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"CPT"}],"standard_charges":[{"gross_charge":711.0,"discounted_cash":711.0,"setting":"both","billing_class":"facility"}]},{"description":"LOWER SPINE BENDING 2/3V","code_information":[{"code":"3201641","type":"CDM"},{"code":"320","type":"RC"},{"code":"72120","type":"CPT"}],"standard_charges":[{"gross_charge":1372.0,"discounted_cash":1372.0,"setting":"both","billing_class":"facility"}]},{"description":"LOWER SPINE BENDING 2/3V-P","code_information":[{"code":"3201641","type":"CDM"},{"code":"320","type":"RC"},{"code":"72120","type":"CPT"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":81.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"LOWER SPINE 6 OR MORE VIEW","code_information":[{"code":"3201650","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"CPT"}],"standard_charges":[{"gross_charge":1646.0,"discounted_cash":1646.0,"setting":"both","billing_class":"facility"}]},{"description":"LOWER SPINE 6 OR MORE VIEW-P","code_information":[{"code":"3201650","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"CPT"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"LOWER SPINE 4 OR MORE VIEW","code_information":[{"code":"3201660","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":1017.0,"setting":"both","billing_class":"facility"}]},{"description":"LOWER SPINE 4 OR MORE VIEW-P","code_information":[{"code":"3201660","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"CPT"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"MANDIBLE COMPLETE-P","code_information":[{"code":"3201750","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"CPT"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","modifiers":"TC","billing_class":"professional","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":11834.48,"10th_percentile":11834.48,"90th_percentile":11834.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":11847.15,"10th_percentile":11847.15,"90th_percentile":11847.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":17764.99,"10th_percentile":17764.99,"90th_percentile":17764.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":40117.28,"10th_percentile":40117.28,"90th_percentile":40117.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":17751.72,"10th_percentile":17751.72,"90th_percentile":17760.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.44,"standard_charge_algorithm":"[All IP services (%BC): 76.44] [All Other IP (%BC): 76.44]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS)