{"hospital_name":"HENRICO DOCTORS HOSPITAL - FOREST CAMPUS","last_updated_on":"2024-10-01","version":"2.2.0","affirmation":{"affirmation":"To the best of its knowledge and belief, the 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 indicated.","confirm_affirmation":true},"hospital_location":["HENRICO DOCTORS HOSPITAL - FOREST CAMPUS","HANOVER EMERGENCY CENTER"],"hospital_address":["1602 SKIPWITH ROAD, RICHMOND, VA, 23229","9275 CHAMBERLAYNE ROAD, MECHANICSVILLE, VA, 23116"],"license_information":{"hospital_license_number":"H-0001855","state":"VA"},"standard_charge_information":[{"description":" Emergency Room ER Beyond EMTALA  ","code_information":[{"code":"452","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":3493.00,"maximum":3893.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Broad","standard_charge_dollar":3893.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"SharedSavings","standard_charge_dollar":3493.00,"methodology":"case rate"},{"payer_name":"Premier Comp Solutions","plan_name":"WorkersComp","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":26741.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":9284.71,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":9362.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":18386.66,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":25290.88,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":23330.38,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":9362.89,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":25290.88,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":11388.59,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":9453.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":18338.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":12460.84,"methodology":"fee 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Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":12902.66,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":9999.20,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":9544.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9090.18,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9090.18,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":15955.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":21947.40,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":20246.08,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":8185.50,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":21947.40,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":10680.90,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":8264.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":15914.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":10813.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15914.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8106.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":8185.50,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":8264.97,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7947.09,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":8344.44,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":8185.50,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":11196.91,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":8741.80,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":8344.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7947.09,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":7947.09,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":10835.98,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":14904.91,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":13749.51,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":5705.54,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":14904.91,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":7418.99,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":5760.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":10807.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":7343.66,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5539.36,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":5816.33,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":5705.54,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":7604.05,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":6093.29,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":5816.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5539.36,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":5539.36,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":28169.37,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":38747.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":35743.42,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":14101.37,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":38747.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":14920.47,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":14238.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":40614.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":26563.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":40614.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13964.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":14101.37,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":14238.28,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13690.65,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":14375.18,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":14101.37,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":31395.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":31395.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":31395.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":19767.58,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":15059.72,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":14375.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13690.65,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13690.65,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":13964.46,"methodology":"fee schedule"}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC ","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":48574.04,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Broad","standard_charge_dollar":27307.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":17415.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"SharedSavings","standard_charge_dollar":25962.00,"methodology":"case rate"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":17561.88,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":35313.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":48574.04,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":44808.66,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":17561.88,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":48574.04,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":19161.94,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":17732.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":35221.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":23932.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35221.49,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":17391.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":17561.88,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":17732.38,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17050.37,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":17902.89,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":17561.88,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":24781.03,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":18755.41,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":17902.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17050.37,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":17050.37,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":27029.45,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":37179.06,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":34297.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":13549.23,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":37179.06,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":15024.19,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":13680.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":26958.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":18318.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":26958.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13417.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":13549.23,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":13680.77,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13154.59,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":13812.32,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":13549.23,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":18967.65,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":14470.05,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":13812.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13154.59,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13154.59,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":13417.68,"methodology":"fee schedule"}]}]},{"description":"MASTECTOMY FOR MALIGNANCY WITH CC/MCC ","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":35985.11,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":26161.43,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":35985.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":33195.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":13128.78,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":35985.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":16736.02,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":13256.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":26093.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":17729.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":26093.14,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13001.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":13128.78,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":13256.25,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12746.39,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":13383.71,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":13128.78,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":18358.53,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":14021.03,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":13383.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12746.39,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12746.39,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":13001.32,"methodology":"fee schedule"}]}]},{"description":"MINOR BLADDER PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":26741.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":16132.21,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":22189.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":20469.77,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":8270.89,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":22189.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":8792.77,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":8351.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":16090.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":10932.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":16090.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8190.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":8270.89,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":8351.19,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8029.99,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":8431.49,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":8270.89,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":11320.62,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":8832.99,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":8431.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8029.99,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8029.99,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":8190.59,"methodology":"fee schedule"}]}]},{"description":"MOUTH PROCEDURES WITH CC/MCC ","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":28739.18,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":20893.59,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":28739.18,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":26511.36,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":10577.17,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":28739.18,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":11702.88,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":10679.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":20839.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":14159.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":20839.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10474.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":10577.17,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":10679.86,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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"},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":13502.19,"methodology":"fee schedule"},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":4064.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":13633.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":3828.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":2204.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":3828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13371.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":13502.19,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":13633.28,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13108.92,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":13764.37,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":13502.19,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":6021.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":6021.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":6021.00,"methodology":"per diem"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":14419.81,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":13764.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13108.92,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13108.92,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":13371.10,"methodology":"fee schedule"}]}]},{"description":"NON-EXTENSIVE BURNS ","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":45133.96,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Broad","standard_charge_percentage":33.00,"standard_charge_algorithm":"Reimbursement will be 33% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":16213.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":16350.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":32812.72,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":45133.96,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":41635.26,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded 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rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":17461.69,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":16667.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15874.26,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":15874.26,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":11206.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":15414.56,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":14219.65,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":5885.00,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":15414.56,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":7889.07,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":5942.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":11177.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":7594.76,"methodology":"fee 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billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":5827.87,"methodology":"fee schedule"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC ","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":33128.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Broad","standard_charge_dollar":26239.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":10942.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"SharedSavings","standard_charge_dollar":20004.00,"methodology":"case rate"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":11034.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":24084.00,"methodology":"case rate","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":33128.00,"methodology":"case rate","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":30561.00,"methodology":"case rate","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":11034.52,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":33128.00,"methodology":"case rate","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":12135.22,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":11141.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":32886.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":21508.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":32886.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10927.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":11034.52,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":11141.66,"methodology":"fee schedule"},{"payer_name":"Employer Direct","plan_name":"COMM","standard_charge_dollar":21500.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars)may be further adjusted for multiple procedure logic."},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross 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Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":15324.46,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":11784.44,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":11248.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10713.13,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10713.13,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":10927.39,"methodology":"fee schedule"}]}]},{"description":"OSTEOMYELITIS WITH CC ","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":26599.92,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":19338.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":26599.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":24537.94,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":9823.85,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":26599.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":13760.91,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":9919.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":19287.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":13105.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":19287.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9728.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":9823.85,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":9919.23,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9537.72,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":10014.61,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":9823.85,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":13570.49,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":10491.49,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":10014.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9537.72,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9537.72,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":9728.48,"methodology":"fee schedule"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":19893.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":4183.21,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":4218.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":7765.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":10681.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":9853.85,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":4218.43,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":10681.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":5150.38,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":4259.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":7745.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":5262.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":7745.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":4177.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":4218.43,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":4259.39,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4095.56,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":4300.34,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":4218.43,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":5449.58,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":4505.12,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":4300.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4095.56,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":4095.56,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":4177.47,"methodology":"fee schedule"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC ","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":34028.74,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":12336.00,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":12439.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":24739.15,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":34028.74,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":31390.90,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":12439.87,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":34028.74,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":16465.87,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":12560.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":24674.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":16765.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":24674.57,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":12319.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":12439.87,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":12560.64,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12077.54,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":12681.42,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":12439.87,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":17360.46,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":13285.29,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":12681.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12077.54,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12077.54,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":12319.09,"methodology":"fee schedule"}]}]},{"description":"OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT ","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":26793.09,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":9809.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":9891.88,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":19478.77,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":26793.09,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":24716.14,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":9891.88,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":26793.09,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":14313.75,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":9987.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":19427.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":13200.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":19427.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9795.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":9891.88,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":9987.91,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9603.76,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":10083.95,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":9891.88,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":13669.04,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":10564.14,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":10083.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9603.76,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9603.76,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":9795.84,"methodology":"fee schedule"}]}]},{"description":"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC ","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":46239.56,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":16600.05,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":16739.82,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":33616.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":46239.56,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":42655.15,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":16739.82,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":46239.56,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":17510.62,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":16902.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":33528.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":22782.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":33528.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":16577.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":16739.82,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":16902.34,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16252.25,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":17064.86,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":16739.82,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":23590.05,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":17877.48,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":17064.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16252.25,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":16252.25,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":158277.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":217710.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":200834.25,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":77122.22,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":217710.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":80406.17,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":77870.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":124748.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":81586.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":124748.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":76373.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":77122.22,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":77870.98,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":74875.94,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":78619.74,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":77122.22,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":138542.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":138542.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":138542.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":111069.59,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":82363.53,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":78619.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":74875.94,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":74875.94,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":76373.46,"methodology":"fee schedule"}]}]},{"description":"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC ","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":20956.89,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":15235.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":20956.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":19332.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":7836.70,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":20956.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":9638.56,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":7912.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":15196.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":10325.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15196.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":7760.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":7836.70,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":7912.78,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7608.45,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":7988.87,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":7836.70,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":10691.58,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":8369.29,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":7988.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7608.45,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":7608.45,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":7760.61,"methodology":"fee schedule"}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC ","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":105479.04,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":76684.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":105479.04,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":97302.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":37600.58,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":105479.04,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":39898.73,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":37965.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":41948.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":27435.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":41948.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":37235.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":37600.58,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":37965.64,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":26134.54,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":35948.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":33161.48,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":13115.75,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":35948.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":14269.61,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":13243.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":40079.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":26213.00,"methodology":"case 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":42529.70,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":58499.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":53964.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":21057.13,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":58499.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":21261.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":31545.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":20726.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":31545.00,"methodology":"case rate"},{"payer_name":"Cigna 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":56350.69,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":77510.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":71502.01,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":27751.65,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":77510.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":29564.67,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":28021.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":56203.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":38189.47,"methodology":"fee 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Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optum Transplant","plan_name":"OON","standard_charge_dollar":26943.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":39543.55,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":29637.69,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":28290.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26943.35,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":26943.35,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":14998.27,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":20630.15,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":19030.93,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":27468.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":37783.23,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":34854.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":13761.97,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":37783.23,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":18691.57,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":13895.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":27396.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":18615.83,"methodology":"fee 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"},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":18184.95,"methodology":"fee schedule"},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":4064.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":18361.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":3828.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":2204.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":3828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":18008.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":18184.95,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":18361.50,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17655.29,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":18538.05,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":18184.95,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":6021.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":6021.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":6021.00,"methodology":"per diem"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":19420.82,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":18538.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17655.29,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":17655.29,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":18008.40,"methodology":"fee schedule"}]}]},{"description":"RADIOTHERAPY ","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":54887.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":19619.76,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":19784.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":39903.25,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":54887.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":50632.25,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":19784.95,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":54887.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":20231.49,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":19977.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":39799.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":27042.86,"methodology":"fee 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":13280.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":18266.90,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":16850.88,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":6889.44,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":18266.90,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":9144.98,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":6956.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":19726.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":15500.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":19726.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":6822.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":6889.44,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":6956.32,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6688.77,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":7023.21,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":6889.44,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":12512.25,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":17210.63,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":15876.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":6517.48,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":17210.63,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":7676.88,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":6580.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":12479.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":8479.69,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6327.65,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":6644.03,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":6517.48,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":8780.35,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":6960.41,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":6644.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6327.65,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6327.65,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":76108.84,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":104687.86,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":96572.65,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":37321.98,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":104687.86,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":40932.76,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":37684.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":61776.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":40402.00,"methodology":"case 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":36234.93,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":38046.68,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":37321.98,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":36767.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":36767.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":36767.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":53408.64,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":39858.42,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":38046.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":36234.93,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":36234.93,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":103930.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":142956.08,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":131874.37,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":50797.86,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":142956.08,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":69396.21,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":51291.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":103658.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":70434.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":103658.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":50304.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":50797.86,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":51291.04,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":49318.31,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":51784.23,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":50797.86,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":72931.95,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":54250.14,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":51784.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":49318.31,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":49318.31,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":19214.33,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":26429.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":24380.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":9763.79,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":26429.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":12422.22,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":9858.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":19164.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":13021.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":19164.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9669.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":9763.79,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":9858.58,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9479.41,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":9953.38,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":9763.79,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":13483.47,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":10427.35,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":9953.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9479.41,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9479.41,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":9669.00,"methodology":"fee schedule"}]}]},{"description":"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY ","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":105826.34,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":76936.52,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":105826.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":97622.86,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":37722.88,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":105826.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":38089.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":67827.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":56975.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":67827.00,"methodology":"case rate"},{"payer_name":"Cigna 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rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":53989.45,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":40286.58,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":38455.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":36624.16,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":36624.16,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross 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","plan_name":"MGMCR","standard_charge_dollar":39167.50,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":39497.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":80599.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":110865.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":102271.12,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":39497.29,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":110865.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":44084.80,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":39880.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":80389.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":54623.36,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":38346.88,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":40264.22,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":39497.29,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":56560.13,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":42181.57,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":40264.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":38346.88,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":38346.88,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":57681.85,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":79341.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":73191.08,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":28396.43,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":79341.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":27719.03,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":28672.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":57531.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":39091.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":57531.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":28120.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":28396.43,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":28672.12,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":27569.35,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":28947.82,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":28396.43,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":40477.68,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":30326.28,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":28947.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27569.35,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":27569.35,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":28120.74,"methodology":"fee schedule"}]}]},{"description":"SPINAL DISORDERS AND INJURIES WITH CC/MCC ","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":41354.82,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":30065.26,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":41354.82,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":38149.07,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":15019.69,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":41354.82,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":18192.89,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":15165.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":29986.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":20375.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29986.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":14873.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":15019.69,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":15165.51,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14582.22,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":15311.33,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":15019.69,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optum Transplant","plan_name":"OON","standard_charge_dollar":14582.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":21098.00,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":16040.44,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":15311.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14582.22,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":14582.22,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":14873.86,"methodology":"fee schedule"}]}]},{"description":"SPLENIC PROCEDURES WITH CC ","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":59874.48,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":43529.18,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":59874.48,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":55233.12,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":21541.26,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":59874.48,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":20746.93,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":21750.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":43415.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":29500.20,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20913.84,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":21959.53,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":21541.26,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":30546.18,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":23005.22,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":21959.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20913.84,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":20913.84,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":13017.22,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":17905.22,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":16517.23,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":6762.07,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":17905.22,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":8713.74,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":6827.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":12983.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":8821.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":12983.24,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":6696.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":6762.07,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":6827.72,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6565.12,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":6893.38,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":6762.07,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":9134.71,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":7221.63,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":6893.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6565.12,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6565.12,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":61304.80,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":84324.87,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":77788.15,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":30151.29,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":84324.87,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":30509.74,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":30444.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":143434.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":73807.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":143434.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":29858.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":30151.29,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":30444.02,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29273.10,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":30736.76,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":30151.29,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":72555.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":72555.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":72555.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":43020.05,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":32200.41,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":30736.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29273.10,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":29273.10,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":21601.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":29713.24,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":27409.93,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":10920.18,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":29713.24,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":11564.75,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":11026.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":21545.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":14639.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21545.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10814.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":10920.18,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":11026.20,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10602.12,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":11132.23,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":10920.18,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":15158.82,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":11662.33,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":11132.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10602.12,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10602.12,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":10814.16,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC ","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":19893.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":13206.96,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":18166.20,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":16757.99,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":6853.98,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":18166.20,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":8915.06,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":6920.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":13172.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":8950.50,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6654.35,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":6987.06,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":6853.98,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":23554.40,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":32399.13,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":29887.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":11866.00,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":32399.13,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":16422.95,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":11981.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":23492.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":15963.08,"methodology":"fee 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":10133.80,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":13939.07,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":12858.53,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":5365.42,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":13939.07,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":7059.29,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":5417.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":10107.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":6867.79,"methodology":"fee 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":21407.53,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":29446.10,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":27163.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":10826.11,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":29446.10,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":11517.14,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":10931.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":21351.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":14508.11,"methodology":"fee 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"},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":10934.67,"methodology":"fee schedule"},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":15928.36,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":11040.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":21575.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":14659.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21575.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10828.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":10934.67,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":11040.83,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10616.18,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":11146.99,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":10934.67,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":15179.78,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":11677.80,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":11146.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10616.18,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10616.18,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":10828.50,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC ","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":103500.07,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":36595.58,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":36903.71,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":75245.31,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":103500.07,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":95476.93,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":36903.71,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":103500.07,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":36289.38,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":37261.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":75048.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":50994.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":75048.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":36545.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":36903.71,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":37261.99,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":35828.84,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":37620.28,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":36903.71,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":52802.67,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":39411.72,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":37620.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35828.84,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":35828.84,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":36545.42,"methodology":"fee schedule"}]}]},{"description":"ANAL AND STOMAL PROCEDURES WITH CC ","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":26741.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":18806.47,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":25868.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":23863.07,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":9566.23,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":25868.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":10777.32,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":9659.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":18757.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":12745.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":18757.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9473.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":9566.23,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":9659.11,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9287.60,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":9751.98,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":9566.23,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":13197.26,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":10216.36,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":9751.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9287.60,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9287.60,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":9473.36,"methodology":"fee schedule"}]}]},{"description":"APPENDIX PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":26741.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":16794.05,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":23100.26,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":21309.56,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":8591.47,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":23100.26,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":8674.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":16750.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":11381.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":16750.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8508.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":8591.47,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":8674.88,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8341.23,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":8758.29,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":8591.47,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":11785.06,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":9175.36,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":8758.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8341.23,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8341.23,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":8508.06,"methodology":"fee schedule"}]}]},{"description":"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC ","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":29450.21,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Broad","standard_charge_dollar":25038.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":10737.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"SharedSavings","standard_charge_dollar":15255.00,"methodology":"case rate"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":10827.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":21410.51,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":29450.21,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":27167.28,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":10827.57,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":29450.21,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":11548.36,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":10932.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":21354.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":14510.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21354.62,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10722.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":10827.57,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":10932.69,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10512.20,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":11037.81,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":10827.57,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":15024.62,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":11563.42,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":11037.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10512.20,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10512.20,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":42782.18,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":58846.98,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":54285.27,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":21179.43,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":58846.98,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":23299.62,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":21385.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":56827.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":37166.00,"methodology":"case 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20562.55,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":21590.68,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":21179.43,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":56299.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":56299.00,"methodology":"case rate"},{"payer_name":"Optima 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":12468.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":17151.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":15821.51,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":6496.49,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":17151.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":8381.62,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":6559.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":12436.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":8450.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":12436.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":6433.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":6496.49,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":6559.56,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6307.27,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":6622.64,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":6496.49,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":11045.14,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":15192.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":14014.91,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":5806.85,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":15192.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":7537.53,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":5863.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":11016.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":7485.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":11016.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":5750.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":5806.85,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":5863.23,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5637.72,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":5919.60,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":5806.85,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":7750.82,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":6201.49,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":5919.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5637.72,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":5637.72,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":5750.47,"methodology":"fee schedule"}]}]},{"description":"CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC ","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":57650.97,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":41912.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":57650.97,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":53181.97,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":20758.26,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":57650.97,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":22251.55,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":20959.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":41803.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":28404.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":41803.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":20556.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":20758.26,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":20959.80,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20153.65,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":21161.33,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":20758.26,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":29411.81,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":22169.02,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":21161.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20153.65,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":20153.65,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":115590.78,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":158995.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":146670.31,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":56445.98,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":158995.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":63433.25,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":56994.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":92578.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":60547.00,"methodology":"case 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":43281.18,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":59533.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":54918.43,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":21421.13,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":59533.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":23966.08,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":21629.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":43080.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":28175.00,"methodology":"case 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"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":6947.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"SharedSavings","standard_charge_dollar":12576.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":7005.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":13520.70,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":18597.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":17156.08,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":7005.94,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":18597.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":6500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":7073.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":15352.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":10042.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15352.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":6937.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":7005.94,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":7073.96,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6801.89,"methodology":"fee schedule"},{"payer_name":"Johns Hopkins","plan_name":"UniformedServicesFamilyHealthPlan","standard_charge_dollar":6725.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":7141.98,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":7005.94,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":17800.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":17800.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":17800.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":10544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":7482.08,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":7141.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6801.89,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6801.89,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":6937.93,"methodology":"fee schedule"}]}]},{"description":"CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES ","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":774944.61,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":271065.87,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":273348.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":563390.39,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":774944.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":714872.26,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":273348.20,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":774944.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":369367.80,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":276002.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":561919.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":381815.78,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":265386.60,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":278655.93,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":273348.20,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optum Transplant","plan_name":"OON","standard_charge_dollar":265386.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":395353.74,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":291925.26,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":278655.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":265386.60,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":265386.60,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":16782.10,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":23083.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":21294.40,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":8585.68,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":23083.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":11092.72,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":8669.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":16738.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":11373.41,"methodology":"fee 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Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":11776.68,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":9169.17,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":8752.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8335.61,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8335.61,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":124599.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":171387.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":158101.38,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":60809.61,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":171387.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":61400.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":122424.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":96600.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":122424.00,"methodology":"case rate"},{"payer_name":"Cigna 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charges"},{"payer_name":"Aetna","plan_name":"Broad","standard_charge_dollar":106226.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":78623.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"SharedSavings","standard_charge_dollar":105055.00,"methodology":"case rate"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":79285.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":162742.91,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":223853.21,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":206500.50,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":79285.23,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":223853.21,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":80054.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":162318.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":110292.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":162318.08,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":78515.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":79285.23,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":80054.99,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":76975.95,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":80824.75,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":79285.23,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":103745.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":103745.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":103745.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":114203.26,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":84673.54,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":80824.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":76975.95,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":76975.95,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross 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charges"},{"payer_name":"Aetna","plan_name":"Broad","standard_charge_dollar":64618.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":56540.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"SharedSavings","standard_charge_dollar":63905.00,"methodology":"case rate"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":57016.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":116768.05,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":160614.69,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":148164.12,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":57016.22,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":160614.69,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":60441.20,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":57569.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":92294.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":60361.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":92294.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":56462.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":57016.22,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":57569.77,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":55355.55,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":58123.33,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":57016.22,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":96003.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":96003.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":96003.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":81940.85,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":60891.11,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":58123.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":55355.55,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":55355.55,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":42758.28,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":58814.10,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":54254.93,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":21167.85,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":58814.10,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":21373.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":42646.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":28977.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":42646.66,"methodology":"fee schedule"},{"payer_name":"Cigna 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rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":30005.21,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":22606.44,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":21578.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20551.31,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":20551.31,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":56792.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":78118.77,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":72063.14,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":27965.86,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":78118.77,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":30816.44,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":28237.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":56644.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":38489.18,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":27151.32,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":28508.89,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":27965.86,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima 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total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":27694.35,"methodology":"fee schedule"}]}]},{"description":"DENTAL AND ORAL DISEASES WITH MCC ","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":33648.57,"payers_information":[{"payer_name":"4Most Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":24462.76,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":33648.57,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":31040.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":12305.99,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":33648.57,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":17084.12,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":12425.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":24398.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":16578.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":24398.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":12186.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":12305.99,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":12425.46,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11947.56,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":12544.94,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":12305.99,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":17166.50,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":13142.32,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":12544.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11947.56,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":11947.56,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":12186.51,"methodology":"fee schedule"}]}]},{"description":"DIGESTIVE MALIGNANCY WITHOUT CC/MCC ","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":19893.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":13190.53,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":18143.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":16737.14,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":6846.02,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":18143.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":7592.97,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":6912.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":13156.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":8939.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13156.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":6779.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":6846.02,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":6912.48,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6646.62,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":6978.95,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":6846.02,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":9256.32,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":7311.28,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":6978.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6646.62,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6646.62,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":6779.55,"methodology":"fee schedule"}]}]},{"description":"DISORDERS OF THE BILIARY TRACT WITH CC ","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":22284.42,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":8234.84,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":8304.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":16200.94,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":22284.42,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":20556.97,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":8304.18,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":22284.42,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":11236.81,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":8384.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":16158.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":10979.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":16158.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8223.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":8304.18,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":8384.80,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8062.31,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":8465.43,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":8304.18,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":11368.85,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":8868.54,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":8465.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8062.31,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8062.31,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":15440.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":21238.43,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":19592.06,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":7935.84,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":21238.43,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":10414.18,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":8012.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":15400.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":10464.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15400.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":7858.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":7935.84,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":8012.89,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7704.70,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":8089.93,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":7935.84,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":10835.21,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":8475.17,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":8089.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7704.70,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":7704.70,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":11657.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":16035.16,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":14792.15,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":6103.55,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":16035.16,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":8048.48,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":6162.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":19726.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":15500.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":19726.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":6044.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":6103.55,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":6162.81,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5925.77,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":6222.06,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":6103.55,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":8180.67,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":6518.35,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":6222.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5925.77,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":5925.77,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":6044.29,"methodology":"fee schedule"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":38170.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":17004.71,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":23390.01,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":21576.86,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":8693.51,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":23390.01,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":8995.67,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":8777.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":16960.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":11524.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":16960.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8609.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":8693.51,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":8777.91,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8440.30,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":8862.31,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":8693.51,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optum Transplant","plan_name":"OON","standard_charge_dollar":8440.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":11932.89,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":9284.33,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":8862.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8440.30,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8440.30,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":8609.10,"methodology":"fee schedule"}]}]},{"description":"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WIT ","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":30079.03,"payers_information":[{"payer_name":"4Most Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":21867.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":30079.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":27747.36,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":11049.00,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":30079.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":14948.35,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":11156.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":21810.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":14819.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21810.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10941.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":11049.00,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":11156.27,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10727.18,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":11263.54,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":11049.00,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":15345.43,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":11799.90,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":11263.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10727.18,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10727.18,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":10941.72,"methodology":"fee schedule"}]}]},{"description":"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC ","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":65353.11,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Broad","standard_charge_percentage":33.00,"standard_charge_algorithm":"Reimbursement will be 33% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":23274.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":23470.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":47512.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":65353.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":60287.05,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":23470.52,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":65353.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":31901.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_percentage":39.00,"standard_charge_algorithm":"Reimbursement will be 39% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_percentage":34.30,"standard_charge_algorithm":"Reimbursement will be 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schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":23242.65,"methodology":"fee schedule"}]}]},{"description":"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC ","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":30938.03,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":11256.71,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":11351.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":22492.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":30938.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":28539.76,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":11351.49,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":30938.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":12439.58,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":11461.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":22433.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":15243.19,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11020.86,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":11571.90,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":11351.49,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":15783.66,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":12122.95,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":11571.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11020.86,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":11020.86,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":420806.02,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":578819.52,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":533950.44,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":204284.12,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":578819.52,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":206267.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":355969.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":235713.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":355969.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":202300.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":204284.12,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":206267.46,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":198334.10,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":208250.81,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":204284.12,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":299127.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":299127.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":299127.00,"methodology":"case rate"},{"payer_name":"Optum Transplant","plan_name":"OON","standard_charge_dollar":198334.10,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":295296.54,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":218167.51,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":208250.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":198334.10,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":198334.10,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":202300.78,"methodology":"fee schedule"}]}]},{"description":"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC ","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":88469.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":30999.01,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":42639.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":39333.88,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":15471.97,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":42639.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":16485.17,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":15622.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":25116.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":16427.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":25116.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":15321.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":15471.97,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":15622.18,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15021.33,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":15772.40,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":15471.97,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":88469.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":88469.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":88469.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":21753.25,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":16523.46,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":15772.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15021.33,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":15021.33,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":44610.84,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":61362.30,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":56605.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":22065.19,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":61362.30,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":29359.19,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":22279.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":44494.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":30233.25,"methodology":"fee 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":18542.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":25504.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":23527.53,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":9438.15,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":25504.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":14340.32,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":9529.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":18493.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":12566.14,"methodology":"fee 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":12207.47,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":16791.41,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":15489.76,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":6369.85,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":16791.41,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":8396.95,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":6431.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":12175.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":8273.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":12175.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":6308.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":6369.85,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":6431.70,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6184.32,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":6493.54,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":6369.85,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":8566.48,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":6802.76,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":6493.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6184.32,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6184.32,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":6308.01,"methodology":"fee schedule"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH MCC ","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":38720.31,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":28149.95,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":38720.31,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":35718.78,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":14091.97,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":38720.31,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":17757.56,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":14228.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":28076.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":19077.53,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13681.52,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":14365.60,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":14091.97,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":19753.95,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":15049.67,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":14365.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13681.52,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13681.52,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":24927.39,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":34287.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":31629.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":12531.04,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":34287.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":14722.25,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":12652.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":24862.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":16893.56,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12166.06,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":12774.36,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":12531.04,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optum Transplant","plan_name":"OON","standard_charge_dollar":12166.06,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":17492.55,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":13382.67,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":12774.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12166.06,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12166.06,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":12409.38,"methodology":"fee schedule"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC ","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":27534.95,"payers_information":[{"payer_name":"4Most Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":20018.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":27534.95,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":25400.48,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":10153.12,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":27534.95,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":11013.00,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":10251.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":19965.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":13566.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":19965.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10054.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":10153.12,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":10251.69,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9857.39,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":10350.26,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":10153.12,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":14047.51,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":10843.13,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":10350.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9857.39,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9857.39,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":16847.84,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":23174.23,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":21377.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":8617.52,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":23174.23,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":11734.48,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":8701.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":16803.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":11417.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":16803.86,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8533.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":8617.52,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":8701.19,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8366.53,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":8784.85,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":8617.52,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":19893.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":11822.81,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":9203.18,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":8784.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8366.53,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8366.53,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":8533.86,"methodology":"fee schedule"}]}]},{"description":"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC ","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":87527.00,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":29361.58,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":40386.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":37256.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":14678.85,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":40386.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":17708.84,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":14821.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":72216.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":47819.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":72216.00,"methodology":"case rate"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":14536.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":14678.85,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":14821.36,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14251.31,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":14963.88,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":14678.85,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":87527.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":87527.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":87527.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":20604.21,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":15676.44,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":14963.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14251.31,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":14251.31,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":14536.34,"methodology":"fee schedule"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WIT ","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":72342.17,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":52593.28,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":72342.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":66734.33,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":25931.67,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":72342.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":28987.18,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":26183.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":52455.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":35643.04,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25176.38,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":26435.20,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":25931.67,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":36906.83,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":27694.02,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":26435.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25176.38,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":25176.38,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":195234.43,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":268545.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":247728.18,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":95023.25,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":268545.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":95265.77,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":95945.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":194724.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":132312.49,"methodology":"fee 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charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":92255.58,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":96868.36,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":95023.25,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":74743.33,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":102809.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":94839.98,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":36660.55,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":102809.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":37016.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":74548.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":50654.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":74548.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":36304.63,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":36660.55,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":37016.48,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":35592.77,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":37372.41,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":36660.55,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":46375.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":46375.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":46375.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":52450.40,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":39152.05,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":37372.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35592.77,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":35592.77,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross 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","plan_name":"MGMCR","standard_charge_dollar":12821.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":12929.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":25750.58,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":35419.98,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":32674.29,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":12929.78,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":35419.98,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":14293.03,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":13055.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":25683.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":17451.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":25683.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":12804.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":12929.78,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":13055.31,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12553.18,"methodology":"fee schedule"},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":13180.84,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":12929.78,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":26741.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":18070.22,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":13808.50,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":13180.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12553.18,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12553.18,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":12804.24,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MC ","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":81803.39,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":59471.66,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":81803.39,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":75462.13,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":29263.37,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":81803.39,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":30453.55,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":29547.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":21236.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":14063.00,"methodology":"case 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":14464.91,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":19896.51,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":18354.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":7463.29,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":19896.51,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":6500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":7535.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":12282.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":8034.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":12282.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":7390.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health Plan","plan_name":"MCR","standard_charge_dollar":7463.29,"methodology":"fee schedule"},{"payer_name":"CorVel","plan_name":"WorkersComp","standard_charge_percentage":72.00,"standard_charge_algorithm":"Reimbursement will be 72% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"DaVita Village Health","plan_name":"MCR","standard_charge_dollar":7535.75,"methodology":"fee schedule"},{"payer_name":"Greenvbrier Sporting Club","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7245.92,"methodology":"fee schedule"},{"payer_name":"Johns Hopkins","plan_name":"UniformedServicesFamilyHealthPlan","standard_charge_dollar":4895.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Lifeworks","plan_name":"MCR","standard_charge_dollar":7608.21,"methodology":"fee schedule"},{"payer_name":"Molina Complete Care (Magellan)","plan_name":"MCR","standard_charge_dollar":7463.29,"methodology":"fee schedule"},{"payer_name":"OccuNet Workers Comp","plan_name":"WorkersComp","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Odyssey HC of Richmond","plan_name":"COMM","standard_charge_dollar":515.00,"methodology":"per diem"},{"payer_name":"Optima Health","plan_name":"HMO","standard_charge_dollar":13787.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Optima Health","plan_name":"POS","standard_charge_dollar":13787.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Optima Health","plan_name":"PPO","standard_charge_dollar":13787.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Oscar","plan_name":"COMM","standard_charge_dollar":10544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Pyramid Life","plan_name":"MGMCR","standard_charge_dollar":7970.51,"methodology":"fee schedule"},{"payer_name":"Sentara Health","plan_name":"MCR","standard_charge_dollar":7608.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7245.92,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":7245.92,"methodology":"fee schedule"},{"payer_name":"Virginia Health Network","plan_name":"COMM","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"ULTRA","standard_charge_percentage":36.00,"standard_charge_algorithm":"Reimbursement will be 36% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Health Network","plan_name":"WC","standard_charge_percentage":61.00,"standard_charge_algorithm":"Reimbursement will be 61% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Virginia Premier Health","plan_name":"MGMCR","standard_charge_dollar":7390.84,"methodology":"fee schedule"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH MCC ","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":435.00,"maximum":86110.66,"payers_information":[{"payer_name":"4Most Health Nework","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MGMCR","standard_charge_dollar":30523.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MGMCR","standard_charge_dollar":30780.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":62603.08,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":86110.66,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":79435.52,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded 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"},{"payer_name":"Anthem","plan_name":"HIX","standard_charge_dollar":25934.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 24% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_dollar":35672.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"HPN","standard_charge_dollar":32907.46,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 30.4% of billable gross charges in addition to the contracteded rate."},{"payer_name":"Anthem","plan_name":"MGMCR","standard_charge_dollar":13018.79,"methodology":"fee schedule"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_dollar":35672.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $847437.00, charges over the threshold will be paid at 33% of billable gross charges in addition to the contracteded rate."},{"payer_name":"BonSecours Hospice","plan_name":"COMM","standard_charge_dollar":435.00,"methodology":"per diem"},{"payer_name":"Bright Health","plan_name":"COMM","standard_charge_dollar":15551.03,"methodology":"fee schedule"},{"payer_name":"Caremore","plan_name":"MCR","standard_charge_dollar":13145.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"HMO","standard_charge_dollar":25866.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"IFP","standard_charge_dollar":17575.99,"methodology":"fee 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