{"hospital_name":"Hardin Memorial Hospital","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Hardin Memorial Hospital"],"hospital_address":["921 East Franklin Street, Kenton, OH 43326"],"license_information":{"license_number":"1196LH","state":"OH"},"type_2_npi":["1437181518","1720010804"],"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":"Girish Dighe"},"modifier_information":[{"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 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Oxygen Addl 15 Min","code_information":[{"code":"27100007","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":16.38,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Artic Gel Cooling (Not Universal)","code_information":[{"code":"27100012","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":7880.96,"discounted_cash":5122.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Metabolic Screen","code_information":[{"code":"27100016","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":244.71,"discounted_cash":159.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pillow 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":21750.42,"10th_percentile":21750.42,"90th_percentile":21750.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":27613.81,"10th_percentile":27613.81,"90th_percentile":27613.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":27863.33,"10th_percentile":27863.33,"90th_percentile":27863.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":39834.85,"10th_percentile":39834.85,"90th_percentile":39834.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":30073.78,"10th_percentile":30073.78,"90th_percentile":30073.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":9535.76,"10th_percentile":9535.76,"90th_percentile":9535.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2907.11,"10th_percentile":2907.11,"90th_percentile":2907.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":19913.55,"10th_percentile":19913.55,"90th_percentile":19913.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":8236.74,"10th_percentile":8236.74,"90th_percentile":8236.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"1 through 10","median_amount":20392.69,"10th_percentile":20392.69,"90th_percentile":20392.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":28970.8,"10th_percentile":28970.8,"90th_percentile":28970.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"1 through 10","median_amount":21251.13,"10th_percentile":21251.13,"90th_percentile":21251.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":8109.56,"10th_percentile":8109.56,"90th_percentile":8109.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":13665.74,"10th_percentile":13665.74,"90th_percentile":13665.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":9860.76,"10th_percentile":9860.76,"90th_percentile":9860.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":18626.27,"10th_percentile":18626.27,"90th_percentile":18626.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":8653.12,"10th_percentile":8653.12,"90th_percentile":8653.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":4945.67,"10th_percentile":4945.67,"90th_percentile":8248.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":8987.48,"10th_percentile":8987.48,"90th_percentile":8987.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":14519.01,"10th_percentile":14519.01,"90th_percentile":17602.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"1 through 10","median_amount":16815.62,"10th_percentile":16815.62,"90th_percentile":16815.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":9679.34,"10th_percentile":9679.34,"90th_percentile":9679.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":9559.2,"10th_percentile":9559.2,"90th_percentile":9559.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":9313.14,"10th_percentile":9313.14,"90th_percentile":9313.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"1 through 10","median_amount":29131.43,"10th_percentile":29131.43,"90th_percentile":29131.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":10569.42,"10th_percentile":10564.05,"90th_percentile":25541.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"1 through 10","median_amount":8122.69,"10th_percentile":8122.69,"90th_percentile":8122.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":2768.76,"10th_percentile":2768.76,"90th_percentile":2768.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":4979.19,"10th_percentile":4979.19,"90th_percentile":10420.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":9080.6,"10th_percentile":9080.6,"90th_percentile":9080.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":9681.14,"10th_percentile":8879.54,"90th_percentile":10012.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"1 through 10","median_amount":13971.96,"10th_percentile":13971.96,"90th_percentile":13971.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":3805.38,"10th_percentile":3805.38,"90th_percentile":3805.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":19721.52,"10th_percentile":19721.52,"90th_percentile":19721.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":9117.14,"10th_percentile":9117.14,"90th_percentile":9117.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5666.8,"10th_percentile":5666.8,"90th_percentile":5666.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"1 through 10","median_amount":10002.03,"10th_percentile":10002.03,"90th_percentile":10002.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":17661.09,"10th_percentile":14521.71,"90th_percentile":29034.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"1 through 10","median_amount":13259.58,"10th_percentile":13259.58,"90th_percentile":13259.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":13001.14,"10th_percentile":13001.14,"90th_percentile":13001.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":13001.14,"10th_percentile":13001.14,"90th_percentile":13001.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":13001.14,"10th_percentile":13001.14,"90th_percentile":13001.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":18626.27,"10th_percentile":18626.27,"90th_percentile":18626.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":20059.38,"10th_percentile":20059.38,"90th_percentile":20059.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"1 through 10","median_amount":14591.2,"10th_percentile":14591.2,"90th_percentile":14591.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":13334.01,"10th_percentile":13334.01,"90th_percentile":13334.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":9860.76,"10th_percentile":9860.76,"90th_percentile":9860.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":15324.63,"10th_percentile":15324.63,"90th_percentile":15324.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":34619.68,"10th_percentile":34619.68,"90th_percentile":34619.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":34526.77,"10th_percentile":34526.77,"90th_percentile":34526.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":21703.55,"10th_percentile":21703.55,"90th_percentile":21703.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":673.56,"10th_percentile":673.56,"90th_percentile":673.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":4831.78,"10th_percentile":4831.78,"90th_percentile":4831.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":9860.76,"10th_percentile":9860.76,"90th_percentile":9860.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"1 through 10","median_amount":4841.84,"10th_percentile":4841.84,"90th_percentile":4841.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"1 through 10","median_amount":5988.25,"10th_percentile":5988.25,"90th_percentile":5988.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"1 through 10","median_amount":44044.72,"10th_percentile":44044.72,"90th_percentile":44044.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 95.4] [All Other IP (%BC): 95.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerihealth","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Blue Access Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 97.1] [All Other IP (%BC): 97.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Buckeye Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 96] [All Other IP (%BC): 96]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and 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":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here:https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All IP services (%BC): 94.6] [All Other IP (%BC): 94.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 5108.24] [Swing Bed-Per Diem: 3523.14]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_na